Curb car use, urges BMA

Cars kill, cars make us fat, says a new report from the British Medical Association. Reduce road space for cars, and give it to cyclists and pedestrians, urges the report.

The British Medical Assocation has published a 103-page report calling on the Government to curb car use, if it wants to improve the nation’s health. ‘Healthy transport = Healthy lives’ stresses the social and economic case for reducing car use, and getting more people to walk and cycle. The report doesn’t pull punches: it’s explosive and powerfully argued.

However, the BMA produced a similar report in 1997, and the recommendations – which were similar to the recommendations in the current report – were ignored by successive Governments.

With a new emphasis on mitigating climate change and the need to reduce the nation’s health bill, perhaps the Government may take heed of this new report? But don’t hold your breath. The BMA stresses that successive Governments have always put cars before people:

“Much of UK policy to date can in part be attributed to the governmental focus on expanding the automotive industry, rather than prioritising the health of the nation.”

The BMA recognises that reducing car use will not be easy but that making such reductions is vital and any delay will be detrimental to health:

“Decisions taken today concerning the UK transport infrastructure can determine how people travel for decades. Making the right decisions, and considering the impact on the health of the community they serve, is vital.”

‘Healthy transport = Healthy lives’ brings together the latest evidence on the impact of transport policy on health. Its aim is to demonstrate to policy makers that integrating health into transport planning will have long-term health benefits for society.

The report, published yesterday, is an update on the BMA’s 1997 publication ‘Road Transport and Health’. It highlights that while there has been little change to transport policy since the earlier report, the detrimental impacts on health continue.

Traffic in the last 60 years has steadily increased, and while car use has brought many social and economic benefits, it has also had negative impacts on health, says the BMA. These include the increased risk of road traffic accidents and greater exposure to air and noise pollution. The increased use of car use has also had the unintended result of far fewer people in the UK walking and cycling.

The health benefits of active forms of travel, such as walking and cycling, are well established, says the BMA. Yet the economy, rather than the health of the nation, is often prioritised when transport policies are developed, says the report.

“Economic considerations have been prioritised over health in transport and urban planning in the last two decades and this has led to increased car use and often expensive and inefficient public transport.

“The report urges the government to introduce transport policies in the UK that will encourage behavioural change so that people use their car less.”

In a foreword to the report, Professor Averil Mansfield, Chairman of BMA’s Board of Science, said:

“Road Transport and Health [of 1997] highlighted the many ways in which transport affects health. There has been little change in transport policy since this publication. The number of car users continues to increase, numbers walking and cycling have stagnated, and changes to the built environment continue to prioritise the ability to travel, rather than the ability to reach destinations. All of which mean that the health of the nation continues to suffer.

“To date the approach to transport policy in the UK has in part been based on short-term objectives, even though the decisions taken can potentially last decades. Economic considerations have been prioritised over health. This is despite a substantial evidence-base demonstrating that making health a key objective in transport policy is cost effective, and will have short-, medium- and long-term benefits. It is vital that we have policies that encourage a modal shift away from unnecessary car use and the development of a transport environment that facilitates active and public transport journeys.”

The lowlight of the report includes a recommendation that all cyclists should be forced to wear helmets but there are a great many highlights in the report.

REDUCE ROAD SPACE FOR MOTOR VEHICLES
“Transport policy should aim to reduce congestion and improve the usability of roads by pedestrians and cyclists through reallocation of road space, restricting motor vehicle access, road-user charging schemes, and traffic-calming and traffic management.”

ELECTRIC CARS TAKE UP SAME SPACE AS NORMAL CARS
“Any efficiency savings in engine technologies should be accompanied by regulation that prioritises active and sustainable forms of transport, and planning decisions that prioritise accessibility over mobility, to ensure efficiency savings are not translated into a higher prevalence of car use.”

BUILD IT AND THEY WILL COME
“While the focus on motorised mobility in the UK throughout the 21st century may have led to dramatic falls in cycling levels, if cycling infrastructure is well integrated into the built environment, there is demand and scope for cycling levels to increase.”

TALK IS CHEAP
“Cycling promotion on its own, without improved facilities and infrastructure, has been less effective. Research conducted in the US in 2007, suggested that combining the use of educational and promotional activities by teachers to motivate parents to walk and cycle to school had no effect on increasing rates of cycling to school. This demonstrates that promotion of cycling alone is insufficient to increase uptake.”

RETHINK ROAD PRIORITIES
“Healthcare organisations should work in partnership with local authorities to ensure local transport plans/infrastructure, and proposals for urban development and regeneration support physically active travel, including prioritising the needs of pedestrians and cyclists over motorists.”

IT’S THE ECONOMY, STUPID
“Active forms of transport, such as cycling and walking, are highly cost effective forms of transport. To the individual, walking has few costs associated with it, while the costs associated with cycling are minimal compared to those of motorised transportation. Active travel contributes savings to healthcare budgets, in terms of savings on treating chronic illness. Transport-related physical inactivity in England is estimated to cost £9.8 billion per year to the economy. This figure is in addition to the £2.5 billion in healthcare costs spent annually on treating obesity.

“A 2007 Cycling England report that estimated the economic value of cycling, found that the health benefits could be valued at £87-300 per cyclist per year, depending on their age, fitness level, and neighbourhood. This did not account for the substantial social benefits of cycling, which include offering more independence to children, improving the quality of life for communities and, in some areas, supporting tourism.

“A 50 per cent increase [in cycling] could lead to health savings of £1.3 billion…All [international] studies reported highly significant economic benefits of walking and cycling interventions. The median result for all data identified was a benefit to cost ratio of 13:1 and for the UK, the figure was higher at 19:1.”

GET PEOPLE OUT OF CARS TO INCREASE HEALTH FOR ALL
“Reducing the negative impact of transport on health will necessitate a shift in societal norms, to one where travelling by car is not always seen as the most effective means of travel. The focus should be on developing an environment where travelling actively or by public transport is as efficient and effective as travelling by car. This will provide a range of co-benefits to the health of the nation, in terms of reductions in road traffic crashes and health-related harms from emissions. It will also contribute to mitigating the impact of climate change.”

POLITICIANS: GROW SOME BALLS
“Achieving [a] shift in UK transport policy requires strong governmental commitment and leadership as the benefit to health will not always be instant. Given transport decisions have the potential to last decades, it is essential the right decisions are made, and health improvement should always be recognised as a pivotal component in transport strategies and programmes.”

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Dr Nathanson said:

“Depressingly, many of our long-sighted recommendations in 1997 have had little impact in forcing politicians to take the action needed to put health at the heart of transport planning.

“Communities are still fragmented by busy roads, reducing the likelihood of children walking to school, and making it difficult for more of us to use active transport — such as walking or cycling — for our short journeys. High traffic density makes active transport unappealing and, especially in the case of pedestrians, dangerous. Parents wanting the best for their children drive them to school, when walking or cycling would have positive health benefits, as well as making a tiny but cumulatively important contribution to reducing greenhouse gas emissions.

“Noise pollution from traffic plays an increasing role. Visitors to British cities often comment on road noise, and its impact on their ability to sleep; we tolerate it, often unaware of the health consequences.

“We understand more about the positive health impact of walking and cycling, of engineering road conditions to make those easier and safer, and to encourage community building.

“We seek to make an impact in the critical area of getting policy makers at national and local government to understand the importance of active transport, and to influence transport policy to support improvements that give us all the opportunity to walk and cycle in far more safety and comfort.

“The report is not anti-car; we explicitly recognise that for many journeys they remain the only feasible option. What we want, what we believe society has a right to expect, is that we will be offered more realistic options for all transport modes.”

Sustrans welcomed the BMA’s new report but cautioned that the Government has a track record of prioritising motoring over health.

Malcolm Shepherd, Sustrans CEO, said:

“The BMA is the biggest, most influential voice in health – when they say our transport system needs a re-think, we know it’s time for politicians, government departments and local councils to take heed.

“Experts have been saying for years that making it easier and safer for people to walk and cycle will help prevent deadly diseases, save lives and save the NHS billions in future healthcare costs.

“Unfortunately things appear to be going in the other direction with the government continuing to prioritise motoring over public transport, walking and cycling.

“The BMA’s call for ambitious targets for walking and cycling – and for the necessary funding to achieve this – is spot on and absolutely critical. We simply cannot afford the future costs of failing to prioritise this.”

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LONGER EXTRACTS FROM THE 2012 and 1997 reports

‘Healthy transport = Healthy lives’, 2012

This report considers the need to prioritise health in transport planning and policy decisions. It aims to highlight the benefits to health of developing a sustainable transport environment where active travel and public forms of transport represent realistic, efficient and safe alternatives to travelling by car.

Over the last 60 years road traffic density in the UK has steadily increased, and congestion in many urban areas is a significant problem. The most significant change in travel behaviour has been in car use, which is seen by many as their primary means of transportation for short and long-distance journeys. This shift has resulted from the increasing affordability of car use relative to other transport alternatives, as well as land use policies that have prioritised mobility over accessibility.

While the expansion in car use has brought many social and economic benefits, the increase in vehicle numbers and traffic volume in the UK has also had negative impacts on health. These include an increased risk of road traffic crashes, as well as greater exposure to air and noise pollution.

Active forms of travel, such as walking and cycling, are the most sustainable forms of transport and are associated with a number of recognised health benefits. These include improved mental health, a reduced risk of premature death, and prevention of chronic diseases such as coronary heart disease, stroke, type 2 diabetes, osteoporosis, depression, dementia, and cancer. Walking and cycling are also effective ways of integrating, and increasing, levels of physical activity into everyday life for the majority of the population, at little personal or societal cost.

The unintended consequence of increased car use has been the suppression of walking and cycling levels in the UK. With the increasing traffic density on UK roads, there has been a corresponding increase in risk of injury for pedestrians and cyclists. This has been coupled with a lack of investment in walking and cycling infrastructure. The decline in active travel has also resulted from poor urban design. Low-density land use patterns (such as urban sprawl) restrict accessibility to jobs, education, services and other destinations by active forms of travel. Even where destinations are geographically near, busy roads and poor infrastructure for active travel can lead to community severance. In many urban areas, travelling by car has become the easiest and safest option for accessing services, irrespective of journey length.

The suppression of active travel in the UK is associated with generally higher levels of physical inactivity and sedentary lifestyles. This in turn can contribute to higher levels of morbidity and mortality through an increased risk of clinical disorders such as cardiovascular disease, overweight and obesity, metabolic disorders, and some cancers.

Strong governmental leadership is needed to re-focus transport policy in the UK.

Prioritising accessibility over mobility will encourage a modal shift towards transport behaviours with the greatest health benefits. This will require measures to reduce the demand and need to travel by car, in tandem with policies that will increase the uptake of active travel and public transport in urban and rural areas. It is essential that planning and land-use policies create an environment that offers everyone (including people whose mobility is impaired) convenient, safe, well-designed and direct access to workplaces, green spaces, homes, schools and other services via active travel and public transport networks.

Transport policy should aim to reduce the need to travel long-distances to access jobs, education, services and other destinations, and encourage a modal shift away from private motor transport towards active forms of travel which benefit health.

This will include:

• prioritising accessibility over mobility in planning decisions to ensure local facilities and services are easily and safely accessible on foot, by bicycle and by other modes of transport involving physical activity

• the provision of a comprehensive network of routes for walking, cycling and using other modes of active travel that offer everyone (including people whose mobility is impaired) convenient, safe, well-designed and direct access to workplaces, homes, schools and other public facilities

• the creation of safe routes to school so that children and parents can travel to school by walking or cycling, and the provision of suitable cycle and road safety training for all pupils.

• Ambitious growth targets for walking and cycling should be set at national and regional levels, with increased funding and resources proportional to target levels.

• Road safety should be addressed at a strategic level through a danger reduction approach that addresses the factors that put pedestrians and cyclists at risk, rather than seeking to reduce casualties by limiting pedestrians and cyclists from making the trips they need to undertake.

Many of the health harms associated with the transport environment can be mitigated with policy action. With demand for transport increasing, health improvement must be an objective in all future transport planning decisions. Decisions taken today concerning the UK transport infrastructure can determine how people travel for decades. Making the right decisions, and considering the impact on the health of the community they serve, is vital.

Much of UK policy to date can in part be attributed to the governmental focus on expanding the automotive industry, rather than prioritising the health of the nation. Increases in car ownership have been further exacerbated by the lack of any realistic alternative.

Motorised transport is heavily dependent on non-sustainable fossil fuels, and burning of these contributes to climate change. Increasing demand for sustainable transport, mirrored by reductions in demand for unsustainable forms of transport, is likely to contribute to mitigating the impacts of climate change. This is in addition to the range of health co-benefits associated with sustainable forms of transport.

While car use has a number of recognised social and economic benefits, car use is also associated with a number of adverse health impacts. Traffic volume, as well as air and noise pollution can lead to negative health outcomes for road users, as well as those living near heavily congested roads. The health impacts of exposure to air pollution from transport exhaust fumes include lower life expectancy, increased risk of cardiovascular and respiratory disease, including myocardial infarction, effects on physical development in children, increased risk of mental illness…

Traffic speeds and volumes are known to influence how individuals choose to travel, with higher school performance in children.

Road traffic crashes are an important health impact from car use. These are not exclusively borne by motorists, and disproportionately affect vulnerable road users, such as pedestrians, cyclists and those from deprived communities.

The relative inexpensiveness of driving a car, compared to other forms of transport, has contributed to its increased use. In 1949, UK car users drove approximately 13 billion miles per year, whereas in 2010 UK car users drove 240 billion miles per year – an almost 16-fold increase. Car ownership has also increased. Between 1994 and 2011 the number of cars licensed for ownership
in Great Britain increased from around 21 million cars to nearly 28.5 million.

The real cost of car use has declined by 17 per cent between 1980 and 2009, and in real terms the average weekly spend on motoring has decreased from £68.27 in 2000-01 to £63.60

Despite the relative inexpensiveness of car use, access is not equitable. The initial high cost of car ownership is prohibitive for individuals from lower socioeconomic backgrounds. The Sustainable Development Commission examined equity and access to transport, and found that in the lowest income quintile, fewer than half of adults hold a driving licence and less than half of households have a car. Half of all households in the highest income quintile have two or more cars. Almost two thirds of those claiming income support or jobseeker’s allowance do not hold a driving licence or have access to a car. This is particularly concerning, given that the marginal costs of car ownership have been shown to be less than public transport costs. The disproportionate impact of transport on the finances of lower income groups has contributed to a situation whereby individuals
in these groups travel up to two and a half times less than those in the highest income bracket.

Reduced traffic volume improves road safety and creates a safer environment for active travel. Modelling has suggested that shifting transport away from car use will have health benefits.

A strategy focusing on reducing car use and increasing walking and cycling in London, for example, will save lives.

These health benefits would be achieved primarily through reductions in local air pollution and increases in physical activity in the population, and are mediated through decreases in ischaemic heart disease, cardiovascular disease (CVD), breast cancer, colon cancer, dementia, and depression.

Reducing car use would also reduce congestion on UK roads. The majority of congestion occurs during peak periods, such as commuting. The average vehicle delay from congestion in the UK in 2010 was approximately 3.55 minutes for every 10 miles travelled. Congestion is reported to be worse in and around towns, as opposed to major travel routes. In many towns and cities, such as Central London, travel by bicycle is faster than driving over short distances, due to severe congestion, and despite the modest state of cycling infrastructure in most urban areas.

Research from the US has estimated that the public health impacts of traffic during periods of congestion may lead to an estimated 3,000 deaths per year. The cost of congestion is high, and can add up to as much as 3 per cent of a city’s gross domestic product (GDP). The Cabinet Office estimates that congestion costs nearly £11 billion per year to the English economy

Congestion is a major problem on many UK roads. Car use in the UK continues to increase at a rate greater than new roads are being built, and new roads appear to encourage more car use.

It is has been suggested by the Transport and Health Study Group (THSG) that the UK road system is saturated, and therefore the development of any new road system will, rather than alleviating congestion, invite more car users. This leads to greater overall emissions, and does not reduce congestion levels. Suppressed demand has meant that more people wish to use roads than there is capacity for. Any new developments to reduce congestion will therefore be negated by roads reaching optimum capacity. It is only through the development of more attractive alternatives to car use that congestion can effectively be reduced.

Measures that discourage car use have been shown to be effective in reducing demand for transport. Reallocation and prioritisation of road space towards more sustainable forms of transport are also effective in promoting their use.

The majority of car journeys in urban areas are less than five miles, so there is scope to reduce the number of shorter car journeys by shifting to active travel, with longer journeys moved to public transport. In London, 11 per cent of all car journeys are less than 1.2 miles, and 55 per cent are less than five miles. Across the UK, nearly one quarter are within one mile, and over 40 per cent are within two miles. This is because the current transport environment favours travelling by car, which for many represents the most convenient and safest method of reaching destinations. With appropriate policy action it is likely that a proportion of these journeys can instead be made by cycling and walking.

Road charging can influence decisions to drive, and positively benefit health through reducing traffic volume and improving local air quality. The introduction of the London congestion zone has been accompanied by reductions in volumes of traffic. By 2009, traffic entering the congestion zone fell by 20 per cent, with traffic within the congestion zone down by 16 per cent, when compared to pre-congestion zone levels. Around 100,000 motorists pay the congestion charge each day. The number of pedestrians and
cyclists entering Central London were also shown to increase following the introduction of the London congestion zone

Parking also creates obstructions that can impair visibility of pedestrians to drivers. This can affect road safety and uptake
The provision, cost and accessibility of parking influences driving behaviour. The THSG have suggested that the provision of free parking in residential, commercial and town centres effectively subsidises car of active travel, as well as contributing to community severance.

The availability of parking in residential and commercial areas encourages driving and discourages partially incurred by local authorities and commercial businesses.

Transport policy should aim to reduce congestion and improve the usability of roads by pedestrians and cyclists through reallocation of road space, restricting motor vehicle access, road-user charging schemes, and traffic-calming and traffic management (including area-wide 20 miles per hour speed limits).

Any efficiency savings in engine technologies should be accompanied by regulation that prioritises active and sustainable forms of transport, and planning decisions that prioritise accessibility over mobility, to ensure efficiency savings are not translated into a higher prevalence of car use.

Suitable provision of cycling infrastructure is likely to reverse this trend. Unlike the rest of the UK, cycling levels in London are increasing. This is attributed, in part, to London having a higher standard of cycling infrastructure and continual investment. These findings suggest that while the focus on motorised mobility in the UK throughout the 21st century may have led to dramatic falls in cycling levels, if cycling infrastructure is well integrated into the built environment, there is demand and scope for cycling levels to increase.

• Ambitious growth targets for walking and cycling should be set at national and regional levels, with increased funding and resources proportional to target levels.

As highlighted previously, nearly a quarter of all car journeys in the UK are within one mile, and over 40 per cent are within two miles. There is also evidence of suppressed demand for active travel. The usage for walking and cycling on the National Cycle
Network, for example, has increased by more than 400 per cent over its lifetime. Research looking at the 2004–05 DfT Sustainable Transport Demonstration Towns programme has also shown potential for change. It was found that almost half of local car trips in the three demonstration towns (Darlington, Peterborough and Worcester) could be made by walking, cycling or public transport under existing conditions, with the main obstacle being lack of awareness of the options.

The greatest potential for changing travel behaviour was found to be increasing cycling, providing a viable alternative to nearly one in three local car journeys.

The Netherlands, Denmark and Germany all have large numbers of cyclists. Research suggests that these high numbers result from the provision of separate cycling facilities along heavily travelled roads and at intersections, combined with traffic calming of most residential neighbourhoods. Extensive cycling rights of way in the Netherlands, Denmark and Germany are complemented by ample bike parking, full integration with public transport, comprehensive traffic education and training of cyclists and motorists, as well as wide public support for cycling. Driving is also expensive and inconvenient in city centres, due to a host of taxes and restrictions on car ownership, use and parking.

In other case studies, cycling promotion on its own, without improved facilities and infrastructure, has been less effective. Research conducted in the US in 2007, suggested that combining the use of educational and promotional activities by teachers to motivate parents to walk and cycle to school had no effect on increasing rates of cycling to school. This demonstrates that promotion
of cycling alone is insufficient to increase uptake.

Healthcare organisations should work in partnership with local authorities to ensure local transport plans/infrastructure, and proposals for urban development and regeneration support physically active travel, including prioritising the needs of pedestrians and cyclists over motorists.

Pedestrians and cyclists are among the most vulnerable road users, and road danger is a barrier to the uptake of active travel. Pedestrians and cyclists have a higher rate of fatality per distance travelled than for any other mode of transport, with the exception of motorcycles.

The WHO recommends that the dangers of roads would be reduced through an approach that prioritises vulnerable road users and limits the speed and volume of traffic through traffic calming measures. This contrasts with a traditional approach, which often seeks to reduce casualties by limiting pedestrians and cyclists from making the trips they need to undertake (eg by the use of guardrails and barriers). Reducing casualties should be considered at a strategic level, through a danger reduction approach that addresses the factors that put pedestrians and cyclists at risk. While the number of pedestrians and cyclists killed will generally be low on these types of roads – because of the high risk – dangerous roads can negatively impact on health through discouraging active travel and through community severance.

Despite cycling levels being very low in the UK, cyclists experience a high rate of injury by distance travelled. Per million kilometres cycled, 0.31 cyclists are killed in road traffic incidents. In spite of the harms cyclists face in terms of safety and exposure to air pollution, a number of studies have found that the health benefits of cycling, such as improved quality of life, weight control, and protecting against major chronic diseases, greatly outweigh these risks, by up to a factor of 20 to 1. The THSG note that, when considered from an absolute risk perspective, cycling is low risk compared to car use, as cycling offers very little harm to other road users, and the health 16 benefits of engaging in cycling outweighs the health harms.

Research on cyclist fatality rates in London between 1992 and 2006 has shown that freight vehicles were involved in more than four out of ten incidents. It has been suggested that to reduce the risk of freight vehicles to cyclists, freight should have restricted access to urban roads, and alternative means of delivering essential goods found. This may include river or rail transport bringing goods into urban environments, and light goods vehicles (LGV) then being utilised for local distribution.

Cycle helmets are designed to prevent injury from low speed crashes. As highlighted in the BMA’s 2010 briefing paper Promoting safe cycling, helmets have been found to be effective at reducing the incidence and severity of head, brain and upper facial injury for users of all ages. Cycle helmet legislation has also been found to increase helmet wearing rates and reduce the number of head injuries.

Cycle helmet wearing is not compulsory in the UK. Although a highly controversial area, with strong proponents for and against, the BMA believes that to reduce some of the dangers to cyclists, cycle helmet wearing should be made compulsory once levels of voluntary helmet wearing are sufficiently high. This requires the implementation of educational and promotional campaigns that aim to encourage cyclists to wear helmets, as well as measures to incentivise their use, such as subsidising the cost of helmets.

Concern has been expressed that compulsory helmet wearing may discourage some cyclists and deter new cyclists, leading to decreased bicycle use, and the loss of the health benefits associated with this form of physical activity. While a number of reviews have considered the impact of this there is no consensus in the scientific literature. To prevent any likelihood of cyclists being discouraged from cycling, the implementation of compulsory helmet legislation in the UK should not be considered in isolation. It is important that the range of measures outlined in this report to encourage and allow children and adults to cycle safely are implemented. In addition to other measures noted in this report, this includes the provision of cycling training for all children, and recognising road safety (including cycling proficiency education) as part of the curriculum for all school children. Cycle training is important for reducing the dangers of the road to cyclists, ensuring cyclists are aware of how to manage traffic, and recognise the safest places to position themselves on roads.

There should be provision of a comprehensive network of routes for walking, cycling and using other modes of active travel that offer everyone (including people whose mobility is impaired) convenient, safe, well-designed and direct access to workplaces, homes, schools and other public facilities.

Active forms of transport, such as cycling and walking, are highly cost effective forms of transport. To the individual, walking has few costs associated with it, while the costs associated with cycling are minimal compared to those of motorised transportation.

Active travel contributes savings to healthcare budgets, in terms of savings on treating chronic illness. Transport-related physical inactivity in England is estimated to cost £9.8 billion per year to the economy. This figure is in addition to the £2.5 billion in healthcare costs spent annually on treating obesity.

A 2007 Cycling England report that estimated the economic value of cycling, found that the health benefits could be valued at £87-300 per cyclist per year, depending on their age, fitness level, and neighbourhood. This did not account for the substantial social benefits of cycling, which include offering more independence to children, improving the quality of life for communities and, insome areas, supporting tourism.

If current levels of cycling could be increased by 20 per cent, it is estimated this could produce health savings of £500 million. Increases by 30 per cent are estimated to lead to savings of £785 million, and a 50 per cent increase could lead to health savings of £1.3 billion. All [international] studies reported highly significant economic benefits of walking and cycling interventions. The median result for all data identified was a benefit to cost ratio of 13:1 and for the UK, the figure was higher at 19:1.

As identified in the 2007 Foresight Project on obesity, given the general increase in sedentary employment and the longer hours worked in the UK over the past decades, there are limited opportunities for other forms of activity during the working day. Policy that optimises the amount of energy expended during routine daily activities, such as travel in the local environment, can have benefits on health. The Foresight Project highlighted “increasing walkability/cyclability of the built environment” as one of the top five policy responses assessed as having the greatest average impact on levels of obesity.

Health transport behaviour requires spaces that are safe, accessible and pleasant, with high quality pedestrian and cycling infrastructure. The 2010 Marmot Review highlighted that well designed, car-free and pleasant streets encourage feelings of well being, social interactions, and promote active travel.

Guidance published by the NICE recommends that:

• pedestrians, cyclists and users of other modes of transport that involve physical activity (including
people whose mobility is impaired) should be given the highest priority when developing or maintaining streets and roads through reallocation of road space, restricting motor vehicle access, road-user charging schemes, traffic-calming schemes, and safer routes to schools
• all planning applications for new developments should prioritise the need for people (including those whose mobility is impaired) to be physically active as a routine part of their daily life

• action should be taken to ensure local facilities and services are easily accessible on foot, by bicycle and by other modes of transport involving physical activity

• the impact (intended and unintended) of any proposed changes to the built environment on physical activity levels should be assessed in advance

• part of the local transport plan block allocation should be apportioned to promoting walking and cycling and other forms of travel that involve physical activity.

Reducing the demand for powered transport can be achieved through a wide range of measures, including good spatial planning. If some of these measures result in increased demand for walking and cycling this should be viewed positively.

One noticeable change of transport use is the increase in car use for very short journeys that began in the late 1970s and 80s — increasing from 3.8% to 6.9% of all journeys of less than half a mile, and up from 14.7% to 24.1% of journeys between half a mile and a mile. As a proportion of all car journeys those of under a mile have increased from 6.4% of car journeys to 8.2%. It is likely that if account is taken of starting up, parking etc, the time by car for these journeys would not be all that different to the time taken to walk and almost certainly longer than the time taken to cycle.

Cycling is the quickest mode of transport in central and inner London. In fact the majority of UK trips are relatively short — 72% of all trips being under five miles in length, however, 59% of such trips are made by car. In terms of time spent travelling approximately 80% is spent travelling by car.

Trends in car ownership are indicative of increasing motorization. Car ownership rose from 5.7 million in 1960 to about 23 million in 1995.

Road traffic is predicted to nearly double by 2025 and despite the economically driven curtailments to the roads programme, traffic growth continues at roughly 3% per year. Even with the small expansion of network capacity that the 1989 roads programme envisaged, supply will be insufficient to meet demand. In addition, measures to reduce the adverse impacts of cars such as emission controls will be outweighed by the increasing number of motor vehicles. It is now widely accepted that it is neither environmentally acceptable nor economically possible to meet this demand for road space.

Current trends suggest that reliance on health damaging forms of transport is growing, and at a time when, for both individual and public health reasons, an increase in the use of health promoting forms of travel could ameliorate growing pressures in both the health and transport sectors. All the important trends reflect increasing volumes of motor traffic, especially in the countryside, with the consequent environmental decline and increasing risk to individual and public health.

In 1995 the British Social Attitudes survey asked people in Great Britain about their attitudes towards policy options for cars. The two most popular options for improvement amongst those surveyed were; reserving streets in towns and cities for pedestrians, and giving cyclists and pedestrians priority in towns and cities even if this makes things more difficult for other road users. Nearly 70% of individuals supported the former measure and just over 60% the latter.

Cycling and walking can be used as key means of transport, whether as a singular mode or as part of a journey incorporating other forms of transport because even use of public transport generally involves a certain amount of walking that door to door transport by car does not.

There is a large body of research evidence relating physical activity to improvements in health status. The clear links between sedentary lifestyles and ill health were highlighted in the government strategy for health The Health of the Nation. Lack of physical activity was identified as one of the four major risk factors for coronary heart disease and stroke. However, over seven in ten men and eight in ten women fall below their ‘age appropriate activity’ level necessary to achieve a health benefit. There is therefore potential to reduce the high rates of coronary heart disease in the UK by increasing physical activity levels and it has been suggested that physical activity is ‘today’s best buy’ in public health, because of the benefits and opportunities.

Cycling is one of the simplest and most effective ways of getting fit, and riding to school or work means physical activity can form part of the daily routine. Cycling also enables a far greater geographical area to be accessed than can be met solely by walking. Yet in the last 50 years, cycling has changed from a mainstream mode of transport to one largely sidelined by policy makers and has declined to a point where cycling now only accounts for 4% of all journeys undertaken.

In 1992, the BMA published an in-depth examination of the health risks and benefits of cycling. Although it was the concern of doctors over the high levels of death and injury caused to cyclists that led to the production of the report, in the course of preparing the document considerable evidence was found of the health benefits for regular cyclists. It was found that an increase in cycling was particularly beneficial in reducing coronary heart disease, obesity and hypertension as well as increasing overall fitness. The report also contained an estimate of the number of years of life lost through cycling accidents compared to the number of years of life gained through improved health and fitness due to regular cycling. It concluded that even in the current hostile traffic environment, the benefits gained from regular cycling were likely to outweigh the loss of life through cycling accidents for the population of regular cyclists. One calculation has shown the ratio to be around 20:1.

A move away from motorized forms of transport to cycling would also lead to reductions in air and noise pollution in towns and cities and largely solve the increasing problem of traffic congestion. There are therefore considerable individual and public health benefits to be gained from an increase in cycling.

concerns have been expressed that encouraging cycling and walking will lead to an increase in casualties and fatalities. This is not the case however, where vulnerable road users are properly catered for. For example, by distance travelled, cycling in the Netherlands is five times safer than in Britain, and in Denmark 12 times. In York, the policy of prioritising health promoting modes of transport, whilst restraining motor traffic has led to casualty reductions well above the national average

There is a growing body of evidence regarding effective measures to increase cycle safety and cycle usage. The experience of other European countries has been analysed in order to propose effective measures for Great Britain. There have been some considerable successes in increasing cycle use in some cities. The most successful cycle policies are those which are part of broader, sustainable transport policies. However, one specific measure which has proven to be central to improving cyclists’ safety is widespread traffic calming to reduce traffic speeds.

Pedestrians and cyclists pose a very small risk to other categories of road user. However, concern is often expressed about ‘dangerous’ cycling, on pavements for example, that may pose a risk to pedestrians, particularly the elderly or younger children. The Cyclists’ Touring Club and Pedestrians’ Association have issued a joint statement on walking and cycling to highlight how solutions to the problems for cyclists and pedestrians are common to both parties and that the priority should be for appropriate road design and reductions in traffic speeds. Shared use of pathways was viewed as a last resort and where it is the only solution, and flows of cyclists/pedestrians are high, a level of segregation should be provided.

Many would argue that the motor car has been one of the principal instruments in the improvement of quality of life for humankind. It has the potential to fulfill many of the individual requirements for a ‘good lifestyle’ as defined within western society — speed, pleasure, access, individualism and personal identity and the use of cars can not be considered solely as a calculated matter of costs and times. However, car drivers have free access to roads and the atmosphere and this imposes costs on others that they do not bear themselves. Everyone has the same claim and the same rights to road space and access so that in the end all of the positive aspects of private motoring become negatives, to a point where supply can no longer match demand. This is where the key to future transport policy lies. Without a fundamental shift in policy away from the car to other forms of transport, it is inevitable that the transport sector will continue to impose large and growing costs on the natural environment, human health and the competitiveness of the British economy.

[We must] change the street environment to deter inappropriate speeds by major investment in area wide traffic calming schemes. This requires substantially increasing expenditure on such measures, which have proved to be far more cost effective than measures to increase road capacity.

[We must] promote positive images for walking and cycling as culturally acceptable modes of travel, as well as being environmentally benign and health promoting.

Increasing motor traffic is a most pressing problem in transport policy today. Strategies to reduce the harmful effects of motor cars such as emission controls are to be welcomed but will be outweighed by projected increases in motor traffic. There is therefore a need to consider reductions in motor traffic. Such reductions could lead to a broad range of health benefits. Physical and mental health and well being should be improved by reductions in air and noise pollution. Raising levels of physical activity in the population, and the health benefits this would confer, could be achieved by creating an environment in which walking and cycling are convenient, safe and easy options. The current transport system, however, does little to encourage and enable these modes. In fact the opposite is true and transport and planning policy has led more people to become dependent on the car, making the environment more hostile for others, including those in motor vehicles. This situation is neither cost-effective nor environmentally sustainable.

The Department of the Environment, Transport and the Regions has yet to be convinced of a net benefit from national road traffic targets to reduce car use unless there is widespread consensus among local authorities. This may, however, be forthcoming, given that local authorities increasingly recognise the need to curb car use, in order to implement sustainable transport policies. The widely supported Road Traffic Reduction Bill was presented to Parliament in November 1996, and has, after some amendment, become an Act of Parliament. This reveals the growing concern about traffic volumes and congestion. Unfortunately, however, even though the Act requires local and regional traffic targets to be set, it does not require the national targets as stated in the original Bill. Until motor traffic growth is halted and reversed, targets for increasing levels of walking and cycling are likely to be hindered by street environments dominated by motorized traffic.

Local and Central Government [must]

• establish road user hierarchies which place pedestrians, people with mobility restrictions, and cyclists at the top and car borne commuters as the bottom, as adopted in cities such as York and Oxford;

• give consideration to city centre car bans;

• develop safe and appropriate facilities for walking and cycling, integrated with public transport;